The nurse prepares to administer regular insulin to a diabetic client whose blood glucose level is 950.

The provider prescribed regular insulin 1 unit/hr intravenously.

Regular insulin is available in a bag containing 10 units of regular insulin in 100 mL solution.

How many milliliters per hour should the nurse set the intravenous pump? Round answer to the nearest whole number.

This case focuses on managing urolithiasis with signs of potential urinary obstruction. Knowledge of the nursing process, prioritization of physiological needs, and the distinction between pain management and critical organ perfusion/output is necessary to determine the first action.

Choice A rationale

Straining urine is important for stone analysis but is not the immediate priority for a client who hasn't voided in 6 hours. Assessment of the underlying cause of urinary retention must occur before focusing on stone recovery procedures.

Choice B rationale

Encouraging fluids helps flush stones but may exacerbate pain or vomiting if a total obstruction is present. The client's lack of output for 6 hours requires an assessment of bladder status before increasing fluid load significantly.

Choice C rationale

Pain management is essential for urolithiasis, but the lack of urinary output is a physiological priority. Assessing for bladder distention or obstruction ensures the kidneys are not sustaining damage from hydronephrosis before focusing solely on symptomatic relief.

Choice D rationale

Assessing for bladder distention is the priority to determine if the client is experiencing urinary retention due to obstruction. Identifying whether urine is being produced but trapped in the bladder is critical for preventing renal injury and hydronephrosis..

Managing disseminated intravascular coagulation involves identifying secondary complications of microvascular thrombosis and hemorrhage. Knowledge of coagulation pathways and end-organ perfusion assessment is required to differentiate between laboratory markers of the disease process and clinical indicators of worsening organ failure.

Choice A rationale

A prolonged prothrombin time, where the normal range is 11 to 13.5 seconds, is a diagnostic laboratory finding for this condition. However, it represents a hematological marker of the clotting cascade exhaustion rather than organ dysfunction.

Choice B rationale

Elevated D-dimer, with a normal range usually less than 500 ng/mL, indicates active fibrinolysis. While it confirms the presence of the disorder and ongoing clot breakdown, it is a laboratory value, not a clinical cue.

Choice C rationale

Capillary refill greater than 3 seconds indicates poor peripheral tissue perfusion. In this condition, microthrombi obstruct small vessels, leading to ischemia. A refill of 5 seconds signals significant circulatory compromise and potential progression toward multi-organ failure.

Choice D rationale

Petechiae and purpura are classic integumentary signs of bleeding due to thrombocytopenia and clotting factor depletion. While they signify active bleeding, they are considered standard symptoms of the disease rather than specific markers of organ dysfunction.

Choice E rationale

Decreased urine output, typically defined as less than 30 mL per hour, indicates impaired renal perfusion or acute kidney injury. This occurs due to microvascular thrombi in the renal capillaries, signaling significant organ dysfunction.

Choice F rationale

A normal platelet count, ranging from 150,000 to 450,000 cells/mm, would indicate improvement rather than worsening. In active cases, platelets are rapidly consumed, leading to severe thrombocytopenia as the body attempts to form micro-clots throughout the vasculature.